1. Full Name of the applicant: 2. Nationality of the applicant:

Transcription

1 FORM I Application for consent for establishment or taking any steps for establishment of Industry operation process or any treatment disposal system for discharge continuation of discharge under section 25 of the Water (Prevention and Control of Pollution) Act, From To, The Member Secretary, State Pollution Control Board-Sikkim, Government of Sikkim, Deorali, Gangtok Sir, I/We hereby apply for consent (ESTABLISH/OPERATE/RENEWAL) under Section 25 of the Water (Prevention and control of Pollution) Act, 1974 (6 of 1974) for establishing or taking any steps for establishment of Industry/operation process or any treatment/disposal system to bring into use any new/altered outlet for discharge of sewage/trade effluent to continue to discharge sewage/trade effluent from land/premises owned by The other relevant details are below: 1. Full Name of the applicant: 2. Nationality of the applicant: 3. (a) Individual Proprietary concern Partnership firm (whether registered or unregistered) (d) Joint family concern (e) Private Limited Company (f) Public Limited Company (g) Government Company (1) State Government (2) Central Government (3) Union Territory (h) Foreign Company (If a foreign company, the details of registration, incorporation, etc.) (i) Any other Association or Body: 4. (i) Name, address and Telephone Nos. of Applicant: (ii) Mobile No. : (iii) ID: 5. Address of the unit: 6. Details of commissioning: (a) Approximate date of commissioning of work. Expected date of production. 7. Attach the list of raw materials and chemicals used per month (a) License Annual Capacity of the Factory/Industry:

2 8. Name of the person authorized to sign this form (the original authorization except in the case of individual proprietary concern is to be enclosed). 9. I. Total number of employee II. No. of employee having valid C.O.I/Sikkim Domicile. (a) Labour /worker Office Adm/account Technical (d) Management 10. Quantity and source of water for: a) Cooling (kilo litres per day) b) Process (kilo litres per day) c) Domestic (kilo litres per day) d) Others (kilo litres per day) 11. State whether you have any treatment plant for industrial, domestic or combined effluents. (Yes/No). If yes, attach the description of the process of treatment in brief. Attach information on the quality to treated effluent vis-à-vis the standards. 12. Sewage and trade effluent discharge (a) (d) Quantum of discharge kilo liter/day Is there any effluent treatment plant If Yes, a brief description of unit Operation with capacity Characteristics of final effluent ph Suspended solids Dissolved solids Chemical Oxygen Demand (COD) Biochemical Oxygen Demand(BOD) Oil and grease

3 (e) (f) Mode of disposal and final discharge Point (enclose map showing discharge Point) Parameters and Frequency of self- Monitoring 13. State details of solid wastes generated in the process or during waste treatment per year. Description Quantity Method of Disposal Bio-degradable Non-bio-degradable Hazardous Waste Liquid Waste Others, if any 14. I/We further declare that the information furnished above is correct to the best of my/our knowledge. 15. I/We hereby submit that in case of change either of the point of discharge or the quality of discharge or its quality, a fresh application for Consent shall be made and until such consent is granted no change shall be made. 16. I/We hereby agree to submit to the State/Central Board an application for renewal for outlet/discharge if to be continued thereafter. 17. I/We undertake to furnish any other information within one month of its being called by the State/Central Board. 18. I/We enclose herewith cash receipt no./bank Draft no.. Dated..amounting Rs.(Rupees...) in favor of Secretary, State Pollution Control Board-Sikkim, as Consent fee. to the Member Yours faithfully, Name & Signature of the applicant

4 FORM II Application for consent for emission/continuation of emission under Section 21 of the Air (Prevention and Control of Pollution) Act, To, The Member Secretary, State Pollution Control Board - Sikkim, Government of Sikkim, Deorali, Gangtok. Sir, I/We hereby apply for CONSENT(Establish/Operate/Renewal) under Section 21 of the Air (Prevention and Control of Pollution) Act, 1981 (14 of 1981) to bring into use a new/altered stack for the discharge of emission/to begin to make new discharge of emission/to continue to discharge emission from stack in industry owned by.. TO BE FILLED IN BY APPLICANT PART A GENERAL 3. (a) Name of Owner/Occupier : Name and address of the unit and location : 4. (a) Total capital invested in the project : Year of commencement of Production : ( c) Whether the industry works general/ 2 shifts/round the clock : 5. (a) List and quantum of products and bye-products : List and quantum of raw materials Used : 6. Furnish a flow diagram of manufacturing process showing input and output in terms of products and waste generated : PART B- Pertaining to stack and vent emissions 9. (a) Number of stacks and vents with height and dia(m) : Quality and quantity of stack emission From each of the above stacks- particulate Matter and Sulphur Dioxide (SO 2 ) (Additional parameters as specified by the concerned Pollution Control Board) : ( c) A brief account of the air pollution control unit to deal with the emission : (a) Parameters and Frequency of self Monitoring: 10. i) Whether Power generator is installed at the unit (Yes/No) : ii) If yes, capacity of the Generator (kva/kw)

5 iii) Types of fuel used: 11. (i) Type and capacity of Boilers: (ii) Fuel used for the boiler: PART C- Pertaining to hazardous waste and hazardous chemicals. 12. Hazardous Wastes: (a) Total quantum of generation : Quantum of hazardous waste generated and its nature, as defined under the Environment (Protection) Act, (See the Hazardous Waste Management and Handling Rules, 1989). : mode of storage within the plant, method of disposal and any other information sought by the concerned Pollution Control Board : 13. (a) Hazardous Chemicals as defined under Environment (Protection) Act, 1986 (see the Manufacture, Storage and Import of Hazard ous Chemicals Rules, 1989) : Whether any isolated storage is involved If yes, attach details Yes/No Whether emergency plants are prepared For taking - on-site measures Yes/No - off-site measures Yes/No I/We declare that the information furnished above is correct to the best of my /our knowledge. Yours faithfully, Name and Signature of applicant.